Disparities in Inpatient Postpartum Pain Assessment and Management: A Cross-Sectional Cohort Analysis at the North Carolina Women’s Hospital

<strong>Background:</strong> Racial and ethnic disparities in postpartum pain care are well-documented, yet the way they manifest at the level of inpatient care delivery remains underexplored. This study examines the frequency, quality, and initiation of inpatient postpartum pain assessment and management by race/ethnicity, language, and delivery type. <strong>Methods:</strong> A cross-sectional cohort analysis was conducted using 160 hours of naturalistic video and audio recordings of 15 postpartum patient dyads at a single academic hospital. Deductive quantitative and inductive thematic coding were employed to quantify and characterize pain-related interactions, with stratification by patient demographics and birth type. <strong>Results: </strong>Black and Hispanic patients experience less and poorer quality pain assessment than Non-Hispanic White patients. Hispanic patients experience less pain management, and Black and Hispanic patients experience poorer quality pain management than White patients.<strong> </strong>Non-Hispanic White patients were prescribed less opioid medication and more coping strategies than Black and Hispanic patients. Themes in pain assessment characterization included self-advocacy, numerical pain rating scale use, depth of discussion, and language barriers. Themes in pain management characterization included self-advocacy, miscommunication around management options, language barriers, and health care team additions to management discussions. <strong>Conclusions:</strong> Disparities in inpatient postpartum pain care are influenced by language barriers, communication gaps, and uneven provider engagement. Standardized protocols promoting inclusive communication, effective use of pain scales, and improved interpreter services are critical for equitable postpartum care.